Eleven chronically malnourished children from a slum in Mumbai were admitted to hospital in June. A survey found that 63% of the children in the slums of Bhandup were malnourished

Three-year-old Jyotsna Mayekar was sitting in a cradle. We were at Chamunda Nagar, a slum colony in east Bhandup. Naresh, her father, a very frail man, told us, “The doctor had said to keep her in hospital for two months. We did keep her for nearly 30 days. But we cannot afford it any more.”

Eleven children, including Jyotsna, all from Mumbai, the country’s financial capital, made it to the headlines in June 2006 after being admitted to a municipal hospital by a non-governmental organisation. They were chronically malnourished.

Doctors at the Rajawadi hospital advised hospitalisation for Jyotsna till she recovered completely. She was diagnosed as a “grade four case” of malnutrition, underweight and unable to walk or talk. But Jyotsna’s family could not afford the extended stay in hospital and brought the child back, hoping she would recover at home.

The walls of their home, made of tattered sackcloth, were stinking on a wet July afternoon. Piles of garbage and waterlogged pathways crisscrossed the unauthorised slum colony. Jyotsna could barely stand on her thin legs. Perhaps she preferred the comfort of the cradle meant for Ganesh, her three-month-old brother. Keeping her in the cradle was one way of keeping Jyotsna from crying for food, which was scarce in the household.

Naresh Mayekar was a manual scavenger; his 55-year-old father Lahu also worked as a scavenger. The two could earn up to Rs 60 on a good day. The residents of apartments in the vicinity haggled fiercely over the amount they would pay the two for cleaning their toilets. A really good day meant cleaning the sewage pipes of an entire housing colony. That was a lot of work but they could earn as much as Rs 100.

On days when there was no work, Naresh had to borrow small sums of money from the neighbours. “Today I borrowed Rs 20 to feed the children,” he said, pointing to the packet of biscuits that would supplement the rice and dal for his daughter and wife, who was still nursing their infant son.

The low quality rice and watery dal could hardly provide Jyotsna the high quality nourishment that she required to bring her health back on track. The family had run out of the iron and vitamin supplements and half a dozen other medicines prescribed by the doctors and supplied free of cost at the public hospital. Naresh had no money to buy the medicines in the market.

In August 2005, a non-governmental organisation, Social Action for Literacy and Health (SALAH), published a report on the status of health and healthcare services in the flood-affected slums of Mumbai. The report highlighted the inadequacies of the public health machinery, which is unable to provide services to match its own disaster management plan.

This prompted SALAH, along with Child Relief and You (CRY), to survey the prevalence and severity of malnutrition among children living in slum colonies, including Chamunda Nagar, in Bhandup. “We approached the state government with the details…and spent the next four months pursuing them to take action,” recalled Madhukant Pathariya, project director of SALAH and Mumbai convenor of the Bal Hakk Abhiyan (BHA). “The government woke up only after we got 11 children admitted to hospital, which led to media headlines.”

Most of the children belonged to families of construction labourers, domestic workers, rag-pickers, scavengers or beggars. “The lack of a regular income for the parents had a direct impact on the children. They were denied the benefits of the public distribution system and anganwadis,” said SALAH activist Aarti Salve.

The NGO demanded that the malnourished children be provided immediate and free medical attention, their impoverished parents be paid a maintenance allowance, and families with an intake of less than 1,800 calories be included in the BPL list and issued the yellow ration cards, besides being provided with amenities like drinking water, sanitation and electricity.

The BHA wrote to the health authorities of Maharashtra, pointing out the high prevalence of malnutrition among children in the Mumbai slums. “The study looked at protein energy malnutrition (PEM). It is characterised by inadequate calories and protein for growth and maintenance. As a consequence it is infants and children that are the most susceptible because their requirements for growth include high energy and protein needs,” a BHA worker said.

The Maharashtra government has done little so far. Chamunda Nagar, a colony of 81 families, has no source of water or access to toilets. The people fetch water from the nearby railway station and defecate along the tracks. “There is a direct link between the unhygienic conditions and the health of the impoverished communities,” a local doctor said, “and it proves fatal in some cases, mostly that of children.”

In Jyotsna Mayekar’s family though, hygiene and nutrition cannot become priorities. “We are manual scavengers. We have to enter the gutters and handle human waste,” Lahu said. Shakuntala, his wife, said people like them, poor and desperate, cannot worry too much even about death. “Of my seven children, only Naresh survived. I can only hope that his daughter Jyotsna survives.”

Measure of misery

Instead of getting grades in school, the children of Mumbai’s slums are being graded on a scale of malnutrition

A survey was conducted in December 2005 of 218 randomly sampled children aged less than one year to 15 years in four slums in Bhandup, Mumbai. It showed that 135 of them were malnourished, 22 were at ‘Grade 3’ of serious malnourishment and 2 at ‘Grade 4’. Two organisations, Social Action for Literacy and Health (SALAH) along with Child Rights and You (CRY), conducted the survey.

The sample size is small, but the survey, which used the WHO’s anthropometric parameters, indicated the prevalence of malnutrition. As many as 63% of the children surveyed were malnourished, a finding consistent with UNICEF’s State of the World Children Report for 2003, which records a 60% prevalence of malnutrition in Indian children.

Of the children surveyed, 11% were chronically malnourished and at major risk of mortality, while 27% were chronically malnourished in terms of weight and height parameters. Many children with milder levels of malnutrition were at high risk of progressing further into a state of emaciation.

Three children were found to have PEM (protein energy malnutrition). This means that they may be getting an adequate intake of energy but poor protein ingestion was resulting in hypoalbumenaemia and oedema. About 35% of the children were found to be anaemic.

According to SALAH, there could be nearly 2 million children in Mumbai living in slums and on pavements whose health conditions must be ascertained. About 55% of Mumbai’s 12-15 million population lives in slum colonies.